Status of Maternal Health and Unsafe
Abortion in Kenya
Prof Japheth Mati
Presented at
Stakeholders’ Consultative Meeting on
STANDARDS AND GUIDELINES (S&G)
for the reduction of morbidity and mortality from
UNSAFE ABORTION
Fairview Hotel, 28 September, 2011
September a rich month for maternal health
news!
Dadaab- a Daily Prayer for Complication-Free Births
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Dr. Beldina Gikundi's daily prayer is that the handful of
malnourished pregnant Somali women who go into labour
that day at the Dadaab refugee complex do not have
complications, which might require a caesarean section.
IPS News 19 September 2011
http://allafrica.com/stories/201109200021.html
Mbale (Uganda) Doctors Held Over
Death of Woman in Labour
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Police have arrested and detained six medical officers of
Mbale Referral Hospital as it commenced an investigation
into the death of a pregnant teacher and her baby two
weeks ago. Cecilia Nambozo, the deceased, a teacher at
Busamaga Primary School in Mbale Municipality, bled to
death allegedly unattended to after failing to raise
Shs300,000 the medical officers had reportedly asked for.
The Monitor, 21 September 2011,
http://allafrica.com/stories/201109210443.html
Elusive Joy for Mothers and Babies as Cartels Run Maternity
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The Report of the Task Force on Pumwani Maternity
Hospital has been handed over to government authorities
for action. ‘Corruption, financial crisis, lack of critical
supplies for mothers and babies, mistreatment of mothers,
moral and ethical decadence, and absenteeism among
doctors, are highlighted as some of the factors that have
compromised the quality of services at the hospital’.
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Daily Nation on the Web 24 September 2011,
http://allafrica.com/stories/201109250047.html
Musyimi Calls for Caution On Abortion
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The Gachoka MP the Rev Mutava Musyimi has called for
dialogue and inclusion of all stakeholders in the on-going
debate by the Kenya Medical Practitioners regarding safe
abortions.
Nairobi Star (Nairobi) 20 September 2011
allafrica.com/stories/201109210120.html
Indicators of
Maternal Health in Kenya
Progress towards achieving MDG 5in Kenya
Target Indicators 2003-2008/9
MDG Target
KDHS
2003
KDHS
2008-9
5.1 Maternal Mortality
ratio (deaths per 100,000
live births)
414
488
5.2 Proportion of births
attended by skilled health
personnel (%)
42
44
5.3 Contraceptive
prevalence rate (%)
39
46
5.4 Adolescent birth rate
(%)
23
18
5.5 Antenatal care coverage 54
(percent made four visits)
47
5.6 Unmet need for family
planning (%)
25.7 (approx 2.4 million
women)
24.5
Fertility preferences among currently married
women (KDHS 2008-09)
6%
14%
53%
27%
W a nts no more child/ha d TL
W a nts w a it 2+ yr
W a nts child <2 yr
Unde cide d or infe cund
Chronic Maternal Morbidity
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Chronic maternal morbidity has received less
attention compared with maternal mortality
Long-term physical, psychological, social and
economic consequences
Chronic ill-health: anaemia, infertility, traumatic
pelvic injuries, obstetric paralysis, chronic PID,
depression and impaired productivity.
Obstetric fistula (VVF and/or RVF)
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True incidence and prevalence of OF unknown
AMREF estimates OF incidence at 3000 new cases
annually with only 7.5% currently receiving treatment.
Other factors that impact on maternal
health
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Sexually transmitted infections have serious impacts on SRH which
include maternal and perinatal morbidity and mortality. HIV/AIDS is a
leading contributor to maternal mortality.
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Gender-based violence impacts profoundly on women's RH- STIs
including HIV, unwanted pregnancies and unsafe abortion and their
complications. One woman in four has been abused during pregnancy
(UNFPA).
Forced first sexual intercourse reported by 12 percent of women
(KDHS 2008-09); and 55% of violated women admitted to the Nairobi
Women’s Hospital are girls aged 0-15 years. SGBV against women
and girls is a persistent occurrence in virtually all violent conflicts.
Harmful practices: early marriage and FGM have serious impacts on
maternal health- maternal and perinatal mortality and morbidity
resulting from labour complications. Obstetric fistula commonly
associated with FGM
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Unsafe Abortion
Unsafe abortion- a public health concern
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In order to achieve MDG 5 on Improving Maternal Health, it is
imperative that the issue of unsafe abortions is addressed.
Unsafe abortion is an important contributor to the high maternal
mortality rates in Kenya
Granted unsafe abortion is simply one of several contributors to MMR,
BUT it is one we know how to prevent- an important public health
principle
Incidence of unsafe abortion generally reflects the magnitude of
unwanted pregnancies in any particular community.
Unsafe abortion can be effectively minimized by ensuring women have
easy access to contraceptive services, backed up by a positive legal
framework that facilitates safe abortion.
A significant proportion of pregnancies
are unintended or mistimed.
Total pregnancies (2003)
Mistimed
30%
Intended
44%
Unintended
26%
Source: SPECTRUM 2.38 Projections
The dilemma of failed contraception
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Nearly a half of Kenyan women (46%) have chosen to practice
contraception
For anyone who chooses to practice contraception the hope is that it
won’t fail.
The realisation that this is not so, though infrequent, is what sends the
hapless woman seeking termination of pregnancy.
Failure to access SAFE Abortion leaves her the option of UNSAFE
Abortion
Ensuring equity in access to safe abortion services should be a key
public health strategy- reaching the marginalised communities, who
are the main victims of Unsafe abortion.
The three-tier scheme for the prevention of
abortion related morbidity and mortality
Level of prevention and
objectives
Interventions
Primary Prevention
Prevent unwanted pregnancy
a) Contraceptive information and
counselling;
b) Contraceptive services
Secondary Prevention
Prevent unsafe abortion
a)
b)
Tertiary Prevention
Post-abortion care = manage
complications; prevent future unsafe
abortion
Counselling in early pregnancy,
respect informed choice;
Ensure access to safe abortion
a) Clinical management of
complications of unsafe abortion or
incomplete abortion;
b) Contraceptive counselling and
services
Thank you